Publications by authors named "Bryan Moon"
Dysregulated FGF23 production is a demonstrated cause of hypophosphatemia and osteomalacia. Diseases associated with these conditions include phosphaturic mesenchymal tumor (PMT) causing tumor induced osteomalacia, various forms of rickets, and fibrous dysplasia (FD). Coexistence of 2 conditions that can increase FGF23 concentrations is rare.
View Article and Find Full Text PDFBackground: Moderately hypofractionated, preoperative radiotherapy in patients with soft tissue sarcomas (HYPORT-STS; ClinicalTrials.gov identifier NCT03819985) investigated a radiobiologically equivalent, moderately hypofractionated course of preoperative radiotherapy (RT) 15 × 2.85 Gy in patients with soft tissue sarcoma (STS).
View Article and Find Full Text PDFBackground: Two-stage revision for periprosthetic joint infection (PJI) in patients who have undergone segmental replacement of the distal femur or proximal tibia after tumor resection can be associated with considerable morbidity, pain, and risk of complications because the procedure often results in removal of long, well-fixed stems from the diaphysis. A less-aggressive surgical approach, such as debridement, antibiotics, and implant retention (DAIR), may be attractive to patients and surgeons because of less morbidity, but the likelihood of eradicating infection in comparison to the traditional two-stage revision is not well established for oncology patients. Furthermore, the relative risk of subsequent amputation for DAIR versus two-stage revision has not been defined for this population.
View Article and Find Full Text PDFRenal cell carcinoma (RCC) bone metastatis progression is driven by crosstalk between tumor cells and the bone microenvironment, which includes osteoblasts, osteoclasts, and osteocytes. RCC bone metastases (RCCBM) are predominantly osteolytic and resistant to antiresorptive therapy. The molecular mechanisms underlying pathologic osteolysis and disruption of bone homeostasis remain incompletely understood.
View Article and Find Full Text PDFObjectives: This study investigates retreatment rates in single-fraction radiation therapy (SFRT) for painful bone metastasis in patients with limited life expectancy. We compared retreatment-free survival (RFS) in patients from a rapid access bone metastases clinic (RABC) and non-RABC patients, identifying factors associated with retreatment.
Methods: In this observational study, we analysed RABC patients who received SFRT between April 2018 and November 2019, using non-RABC SFRT patients as a comparison group.
Introduction: Pelvic metastasis is a common presentation among patients presenting with skeletal metastasis. Image-guided percutaneous cementation of these lesions is becoming increasingly popular for the treatment of these lesions. The objective of this study was to conduct a systematic review that investigates clinical outcomes after percutaneous cementation for pelvic metastasis.
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- A randomized phase 2 trial was conducted to evaluate the effectiveness of neoadjuvant immune checkpoint blockade (ICB) therapies (nivolumab and nivolumab/ipilimumab) in patients with resectable retroperitoneal DDLPS and extremity/truncal UPS.
- The primary endpoint of pathologic response showed a median hyalinization of 8.8% in DDLPS and 89% in UPS, with secondary endpoints focusing on immune changes and survival rates over time.
- Results indicated that lower pre-treatment regulatory T cell densities correlated with better pathological outcomes, and that neoadjuvant ICB led to significant immune changes and benefits, particularly in patients with UPS when combined with radiation therapy
Background: Outcomes of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) in the oncologic population are limited. We sought to examine the safety and effectiveness of TMR and RPNI in controlling postamputation pain in the oncologic population.
Study Design: A retrospective cohort study of consecutive patients who underwent oncologic amputation followed by immediate TMR or RPNI was conducted from November 2018 to May 2022.
Imaging should be performed in patients with a suspected soft tissue mass that cannot be clinically confirmed as benign. Imaging provides essential information necessary for diagnosis, local staging, and biopsy planning. Although the modalities available for imaging of musculoskeletal masses have undergone progressive technological advancements in recent years, their overall purpose in the setting of a soft tissue mass remains unchanged.
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- The study investigates the effectiveness and complications of cemented intercalary endoprosthetic reconstruction in 19 patients with metastatic lesions in long bones, focusing on patient survivorship and revision rates.
- It aims to determine the cumulative incidence of revision for any reason, assess complications associated with the procedure, and evaluate functional outcomes using the MSTS93 score.
- Findings show a range of patient ages, a median follow-up of 24 months, and highlight the prevalence of renal cell carcinoma among the cases studied.
Background: Forequarter amputations (FQAs) and extended forequarter amputations (EFQAs) are rare procedures with high morbidity that often require significant soft-tissue or bony reconstruction. The authors describe the largest series of oncologic FQAs and EFQAs to date with associated reconstructive and oncologic outcomes.
Methods: The authors retrospectively reviewed data from all patients who underwent FQA or EFQA at The University of Texas M.
Background: Regional lymph node metastasis in extremity and trunk soft tissue sarcoma (ETSTS) is rare with no standardized management. We sought to determine management patterns for regional lymph node metastasis in ETSTS.
Methods: A survey regarding the management of ETSTS lymph node metastasis was distributed to the membership of the Musculoskeletal Tumor Society (MSTS) and the Society of Surgical Oncology (SSO) in January 2022.
Article Synopsis
- The study focuses on evaluating the safety of a shorter, moderately hypofractionated radiotherapy regimen (42.75 Gy over 15 fractions) for patients with non-metastatic soft tissue sarcomas, compared to the standard regimen of 50 Gy over 25 fractions.
- Conducted at MD Anderson Cancer Center, the trial aimed to determine if the new regimen would result in fewer major wound complications within 120 days post-surgery, which historically affect about 35% of patients.
- A total of 120 patients were enrolled from December 2018 to January 2021, and the trial has been registered for ongoing follow-up to assess safety and outcomes.
Article Synopsis
- Periprosthetic infections significantly contribute to the failure of segmental endoprosthetic reconstruction, prompting a study to assess the impact of surgical drain output on infection risk.
- A review of 295 patients revealed that 10.5% developed infections, with Staphylococcus aureus being the most common culprit, and showed no significant difference in infection rates whether drains were removed at ≤ 30 mL/day or > 30 mL/day.
- Key findings indicated that factors like having a sarcoma diagnosis or receiving preoperative chemotherapy were strong predictors of infection risk, suggesting that the 30 mL/day drain output criterion is not effective for reducing infections after surgery.
Purpose: In an effort to promote cost-conscious, high-quality, and patient-centered care in the palliative radiation of painful bone metastases, the National Quality Forum (NQF) formed measure 1822 in 2012, which recommends the use of one of the four dose-fractionation schemes (30 Gy in 10 fractions, 24 Gy in 6 fractions, 20 Gy in 5 fractions, or 8 Gy in a single fraction). We investigated whether a custom electronic health record (EHR) alert system improved quality measure compliance among 88 physicians at a large academic center and institutional network.
Methods: In March 2018, a multiphase alert system was embedded in a custom web-based EHR.
Article Synopsis
- The text outlines a multi-specialty strategy and guidelines from a Case Review Committee aimed at managing oncologic surgery procedures in a cancer center during the ongoing COVID-19 pandemic.
- It emphasizes the importance of strategic rescheduling to reduce COVID-19 exposure risks while conserving healthcare resources, acknowledging a need for continued careful scheduling as society adapts to living with COVID-19.
- The approach involves input from various surgical departments, focusing on the role of cancer surgeons in safely assessing the timing of surgeries based on factors like tumor biology and treatment responses.
Background: The objective of this study was to evaluate treatment outcomes for patients with desmoid tumors (DTs) receiving local therapy with surgery alone, radiation therapy (RT) alone, or combined modality therapy (RT and surgery).
Methods: This was a cross-sectional cohort study of 412 patients with nonmesenteric DTs who received local therapy at the authors' institution between 1965 and 2018.
Results: The median follow-up time was 95 months (range, 1-509 months).
Article Synopsis
- This study analyzed treatment outcomes and recurrence rates in 41 patients with localized extraskeletal myxoid chondrosarcomas (EMCs) over a 26-year period, focusing on the effectiveness of combined surgery and radiation therapy versus surgery alone.
- Results showed that patients receiving combined therapy had significantly better local control, with 90% achieving this outcome over 10 years compared to 63% for those who only had surgery.
- The findings suggest that combining surgery with radiation therapy is crucial for reducing the risk of local and distant recurrence in EMC patients, highlighting the importance of optimal treatment strategies.
Article Synopsis
- The study examines factors affecting overall survival in patients with Ewing sarcoma (ES) who experience local recurrence, highlighting that local recurrence often leads to a poor prognosis.
- Out of 26 patients treated from 1992 to 2017, only 27% were alive at the last follow-up, with survival rates significantly better for those treated with surgical methods like wide excision and for those without metastasis.
- The findings suggest that achieving complete eradication of recurrent disease is crucial for improving survival rates and that routine amputation is not necessary for managing local recurrence.
Purpose: To characterize local relapse after surgical fixation and postoperative radiotherapy (RT) for multiple myeloma (MM) with cortical involvement of long bones.
Patients And Methods: We retrospectively identified patients with MM involving cortical long bones treated with surgical fixation followed by postoperative RT at our institution. Local failures, defined as radiographic recurrence along the surgical hardware, were documented, and potential associations of independent variables (RT dose, fractionation, and extent of hardware coverage) with local failure were assessed by univariate Cox regression.
Importance: Consensus is lacking as to the optimal radiotherapy dose and fractionation schedule for treating bone metastases.
Objective: To assess the relative efficacy of high-dose, single-fraction stereotactic body radiotherapy (SBRT) vs standard multifraction radiotherapy (MFRT) for alleviation of pain in patients with mostly nonspine bone metastases.
Design, Setting, And Participants: This prospective, randomized, single-institution phase 2 noninferiority trial conducted at a tertiary cancer care center enrolled 160 patients with radiologically confirmed painful bone metastases from September 19, 2014, through June 19, 2018.
Article Synopsis
- Tumor-induced osteomalacia is a rare condition resulting in low phosphate levels and weak bones, often due to an underlying tumor.
- A 42-year-old man experienced pain and multiple bone fractures, leading to a diagnosis that involved imaging revealing a bone tumor in his jaw.
- Successful treatment included surgical removal of the tumor and subsequent reconstruction, resulting in normalization of his phosphate levels.
Objective: We evaluated our experience treating patients with extraskeletal osteosarcoma (ESOS) using combined modality local therapy, including surgery and radiation therapy (RT), to investigate local control (LC) and other survival endpoints.
Methods: We reviewed the records of 21 consecutive patients with nonmetastatic, ESOS treated with RT in combination with surgery at our institution from 1984 to 2015. Postoperative RT was used for 10 patients (48%) to a median dose of 60 Gy (range, 60 to 68 Gy).
Purpose: To update our experience with long-term outcomes in patients with desmoid fibromatosis treated with radiation therapy (RT) and to characterize factors associated with increased risk of local recurrence.
Methods And Materials: We reviewed the records of 209 consecutive patients with desmoid fibromatosis treated with RT, either alone or as combined-modality therapy (CMT) with surgery, at our institution from 1965 to 2015.
Results: Median follow-up time was 98 months (range, 1-509 months).
Background: Open biopsy of bone is the diagnostic benchmark for the diagnosis of skeletal lesions. Intraoperative pathology consultation with frozen section analysis is commonly performed to confirm adequacy of lesional tissue and guide intraoperative decision making. The purpose of this study was to determine the accuracy and clinical utility of intraoperative frozen section during open bone biopsy.
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